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Organization

VALLEY DERMATOLOGY CLINIC PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY KELLY MD (OWNER)
(701) 293-7408
Entity
Organization

Contact information

Practice address
3270 20TH ST S, FARGO, ND 58104-5917
(701) 293-7408
(701) 235-2099
Mailing address
3270 20TH ST S, FARGO, ND 58104-5917
(701) 293-7408
(701) 235-2099

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
06546001
BLUE SHIELD
ND
05
13495
ND
01
510R8VA
BLUE SHIELD
MN
Enumeration date
11/08/2006
Last updated
08/22/2020
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